Bergamo, a city of 120,000, with about a million more in the surrounding province, sits at the foothills of the Alps, 25 miles northeast of Milan. Travel guides describe how the upper part of the city, perched high on a hill and encircled by walls, is connected to the lower part by walking paths and a funicular. 

The city is known for its spectacular medieval architecture. The area, home to San Pellegrino sparkling water and a manufacturer of brakes for Formula One cars, is also a busy transit hub, with an airport that serves over 12 million passengers a year. Doctors tell me the province of Bergamo has been hit the hardest by this pandemic.

The clinical picture was different from what Duca and his colleagues expected. “The virus is as free as the wind,” Pietro Brambillasca, an anesthesiologist who works with Duca, tells me over the phone. “It does whatever it wants.”

The patients keep coming. Beds fill up. Ventilators get parceled out. Quickly, there are many more patients than equipment and space. Doctors can be recruited, or take on more patients than they are usually comfortable with, but what to do about the lack of resources? Who gets the precious few ventilators?

Those deemed too old or too sick don’t get ventilators or have them taken away so that they can be used for patients who are more likely to survive.

Duca recalls for me one of the first patients he subjected to this calculation. The man, 68, had transplanted lungs. His oxygen level had dropped; his breathing rate increased. “I knew that he was not doing well,” Duca says. But there were no spots in the I.C.U., because they were filled with younger and healthier patients whose prospects of recovery were greater. 

Duca made the difficult decision not to give the patient a breathing tube, to save the ventilator for someone more likely to live.

Family members weren’t allowed into the hospital because they, too, could get infected or spread the virus to others if they themselves were sick. But Duca asked for permission from his supervisor to let the man’s wife and daughter in, just fora few minutes. “I saw his face when he looked at his wife coming inside this room,” Duca recalls. “He smiled at her. It was a fraction of a second. He had this wonderful smile.” He continues: “Then I saw that he was looking at me. He realized that there was something wrong if only his relatives were coming inside.” The man knew in that instant that he was going to die, Ducasays. As the man’s breathing worsened, morphine was started. He died 12 hours later.

“Which one is the lucky man of the day?” Brambillasca asks. He normally cares for very sick children who have had organ transplants, but since the outbreak, he has been called to float between the E.R. and the I.C.U. 

When we speak by phone one morning, on one of my days off, he sounds defeated. His wife, an otolaryngologist, has also been recruited to the effort: She is now working in a Covid unit in a neighboring hospital. I can hear their 1-year-old daughter in the background. Every day, Brambillasca feels inadequate. 

“I ask myself if I’m more useful if I go outside my home, take paper and alcohol and disinfect the doorknobs of my neighbors instead of going to work as a doctor,” he says.

Brambillasca tells me about how he had two patients side by side one day.

One man was around 65 and had been on a ventilator for 10 days. He had heart problems, and he wasn’t improving. 

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